<div class="row box-register">

<form name="RegisterForm" method="post" action="pages/pExRegister.php?act=do" id="RegisterForm" class="form-horizontal">
    <span id="lbError"></span>
    <fieldset>
        <legend>
            <h3>Đăng ký thành viên</h3>
        </legend>

        <h5><span class="badge">1</span> Thông tin đăng nhập</h5>
            <div class="row">

                <div class="control-group">
                    <label class="control-label" for="txtUsername"><span class="required">*</span>Tên đăng nhập</label>
                    <div class="controls">
                        <input name="txtUsername" type="text" id="txtUsername" class="input-xlarge required" placeholder="Tên đăng nhập">
                    </div>
                </div>


                <div class="control-group">
                    <label class="control-label" for="txtMatKhau"><span class="required">*</span> Mật khẩu</label>
                    <div class="controls">
                        <input name="txtMatKhau" type="password" id="txtMatKhau" class="input-xlarge required" placeholder="Mật khẩu">
                    </div>
                </div>
                <div class="control-group">
                    <label class="control-label" for="txtXNMatKhau"><span class="required">*</span> Xác nhận mật khẩu</label>
                    <div class="controls">
                        <input name="txtXNMatKhau" type="password" id="txtXNMatKhau" class="input-xlarge required"placeholder="Xác nhận mật khẩu">
                    </div>
                </div>

            </div>

            <h5><span class="badge">2</span> Thông tin cá nhân</h5>
                <div class="row">

                    <div class="control-group">
                        <label class="control-label" for="txtEmail"><span class="required">*</span> Email</label>
                        <div class="controls">
                            <input name="txtEmail" type="text" id="txtEmail" class="input-xlarge email required" placeholder="Email">
                        </div>
                    </div>

                    <div class="control-group">
                        <label class="control-label" for="txtHoVaTen"><span class="required">*</span> Họ và Tên </label>
                        <div class="controls">
                            <input name="txtHoVaTen" type="text" id="txtHoVaTen" class="input-xlarge required" placeholder="Họ và Tên">
                        </div>
                    </div>

                    <div class="control-group">
                        <label class="control-label" for="txtSoDienThoai"><span class="required">*</span> Điện thoại </label>
                        <div class="controls">
                            <input name="txtSoDienThoai" type="text" id="txtSoDienThoai" class="input-xlarge required" placeholder="Điện thoại">
                        </div>
                    </div>

                    <div class="control-group">
                        <label class="control-label"><span style="color:red">*</span>Sinh Nhật</label>
                        <div class="controls">
                            <div class="row-fluid">
                                <select name="ddlday" id="ddlday" style="width:90px;">
                                    <option selected="selected" value="" >Ngày</option>
                                        <script type="text/javascript">
                                            for (var i=1; i<=31; i++)
                                            {
                                            document.write("<option>"+i+"</option>");
                                            }

                                        </script>
                                </select>

                                <select name="ddlMonth" id="ddlMonth" style="width:90px;">
                                    <option selected="selected" value="">Tháng</option>
                                    <script type="text/javascript">
                                            for (var i=1; i<=12; i++)
                                            {
                                            document.write("<option>"+i+"</option>");
                                            }

                                    </script>
                                </select>

                                <select name="ddlYear" id="ddlYear" style="width:100px;">
                                    <option selected="selected" value="">Năm</option>
                                    <script type="text/javascript">
                                            for (var i=2008; i>=1920; i--)
                                            {
                                            document.write("<option>"+i+"</option>");
                                            }
                                    </script>
                                </select>

                                <br>
                                    <span style="font-size:11px;color:red;"><span id="lbldrpErr"></span></span>
                            </div>
                        </div>
                    </div>

                    <div class="control-group">
                        <label class="control-label" for="txtDiachi">Địa chỉ</label>
                        <div class="controls">
                            <input name="txtDiachi" type="text" id="txtDiachi" class="input-xlarge" placeholder="Địa chỉ liên lạc">
                        </div>
                    </div>


                    <div class="control-group">
                        <label class="control-label">Giới Tính</label>
                        <div class="controls">
                            <div class="row-fluid">
                                <select name="txtgioitinh" id="txtgioitinh" style="width:120px;">
                                    <option selected="selected" value="" >Chọn giới tính</option>
                                    <option>Nam</option>
                                    <option>Nữ</option>

                                </select>

                    <br>
                                    <span style="font-size:11px;color:red;"><span id="lbldrpErr"></span></span>
                            </div>
                        </div>
                    </div>

                    <div class="control-group">
                        <label class="control-label"><span class="required">* Các trường bắt buộc</span></label>
                    </div>
                    <div class="controls">

                </div>

                </div>


    <div>
        <input type="submit" name="btnSubmit" value="Đăng ký" id="btnSubmit" class="btn" >
        &nbsp;
        <input type="button" id="btnSupport" class="btn btn-success" value="Nhập lại"  onClick="parent.location='index.php?a=2'">
    </div>

    </fieldset>
</form>
</div>


